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Changing the focus of hospital food standards

Feature: Catering

Do the Government Buying Standards have the scope and depth necessary to make a real impact on the catering system? Rosemarie Hoyle investigates

In 2014, the Hospital Food Standards Panel (HFSP), an independent group established by the Department of Health and led by the chairman of Age UK, published a report on catering standards in NHS hospitals. The main body of the report contained a series of recommendations and five food standards which hospitals should follow. One set of standards were the Government Buying Standards. These cover issues of sustainable procurement, healthier eating across the entire hospital community and the nutritional needs of patients. They were positively received and, from April 2015, were written into the NHS Standard Contract. For the first time, food standards became mandatory for NHS England.

Each year, around £2.4 billion is spent on public sector food and catering. How this money is spent can influence three things: the health of the nation; the use of environmentally sustainable food; and support for the British food and farming industry. Therefore, the introduction of mandatory standards, which affect how this public money is spent, was a significant step in the right direction.

Despite this and some reports of rising standards, local and national press continue to report negatively on issues surrounding hospital catering. Meals of substandard quality, with insufficient nutritional value and general lack of choice are reported so often, that the standard of hospital food has become something of a talking point. It is no surprise, that the first question asked when someone is discharged is; ‘how was the food?’.

Impacting the catering system
Two years since the introduction of compulsory standards and negative discourse around hospital food dominates now, more than ever. Clearly something is amiss, raising the question: do the Government Buying Standards have the scope and depth necessary to make a real impact on the catering system?

Although the standards have set a good foundation for hospital caterers, covering issues such as production, processing and distribution, animal welfare, environment and resource efficiency, there are areas where they arguably fall short. For example, in the social-economic region. The standards cover equality and diversity, inclusion of SMEs and outline at least 50 per cent of tea and coffee should be fairly traded. However, there are no regulations surrounding the ethical trade of other ingredients and hospitals are not encouraged to support movements such as the Ethical Trade Initiative. Furthermore, the standards do not touch upon the fair payment of those in the supply chain, with no proposal of backing Living Wage Employers.

Although headway has been made in most areas, in particular production, processing, distribution and environment, these are not the most pressing areas in terms of patient satisfaction and health. When the topic of hospital food hits the headlines, for the majority of the time, this is in relation to the quality, nutrition and taste of food. For unwell patients wanting to get better, these are the areas which matter most. Yet they receive little to no focus across the standards.

Another of the five standards recommended by the HFSP and made mandatory in 2015 was the British Dietetic Association (BDA) Digest. The Digest is a reference document designed for use in hospital and care settings with sections on nutritional analysis and menu design. However, the procurement of nutritious foods is the first step towards positively influencing a patient’s diet and the Government Buying Standards lack detail in this area. If procurers were given comprehensive guidance on buying nutritious meals and foods, this would set the catering sequence off the best possible start.

The current standards give direction on buying foods with reduced salt, saturated fat and increasing fruit and vegetable, fibre and fish consumption. Despite this, menu cycle analysis is only included in the best practise section and is therefore not a legal requirement, meaning ingredient purchases can be made without consideration of the nutritional value towards a meal. Additionally, controversial ingredients such as artificial trans fats and GM ingredients are permitted.

A change of focus
Furthermore, there are no stipulations in the Government Buying Standards regarding the quality of food procured and served. In fact, this is not touched upon in any of the five standards introduced. For a hospital patient, mealtimes may well be a highlight of the day. Even if meals and ingredients are ethically sourced, kind to the environment and nutritious, if they are badly presented and bad tasting, patients will ultimately be dissatisfied.

Clearly, there needs to be a change of focus. The standards cover a range of topics and their introduction was a crucial step towards regulating the food served in hospitals. Yet there are notable gaps and there has been criticism that they are weak, only reflecting basic catering standards.

Additionally, a review of progress two years after the HFSP’s report found widespread breaches of what were meant to be mandatory standards. For example, 48 per cent of hospitals were found to be non-compliant with the Government Buying Standards, whilst only 55 per cent of hospitals follow the BDA’s Nutrition and Hydration Digest.

Arguably, there are two issues at hand. Firstly, the food standards introduced into the NHS Standard Contract are not comprehensive enough. Secondly, no real regulatory programme has been introduced, this leading to slow adoption of the standards.

Public sector catering will always face criticism and ensuring a high standard of food is served across hospitals will be a long and difficult battle. Great progress has been made, however there needs to be a change of focus - to the needs of the patient. Once patient satisfaction has been improved, so will public opinion. Standards need to be comprehensive across all areas, set down in legislation, with a strict supervisory process. Without this, there is risk they will be only partially adhered to or simply ignored, leaving Trusts in a halfway house.